EMT-Basic Exam: The Basics of Pediatric Care (Infants and Children) - Treating Children with Special Needs

As an EMT, you will occasionally travel to a home in which a child with special needs has been injured or is ill. These children are often dependent on an array of medical technology, including instruments that help them breathe and eat or machines that administer medication. These machines may fail, requiring assistance from EMS. Questions about responding to calls involving children with special needs will most likely appear on the EMT-Basic exam, so be sure to review what you already know about tracheostomy tubes, ventilators, and shunts.

1. Ventilators
Children who cannot breathe completely independently are often placed on mechanical ventilators for assistance. Parents typically understand the operation of ventilators, so the most common call EMS crews receive involving these machines concerns their failure or malfunction.
In the instance of a home ventilator failure, use a bag-valve mask to ventilate and transport the child to a medical care facility. If the child has a tracheostomy, connect the bag-valve mask directly to the tube.

2. Tracheostomy Tubes
A common intervention for children with respiratory issues is the insertion of a tracheostomy tube. During surgery, a physician cuts an opening into the trachea and inserts a plastic or metal tube to help the child breathe. If the tube falls out or becomes obstructed, the child’s life may be in danger.
If you are called to a scene where the tube has fallen out and cannot be safely reinserted, ventilate the child using a bag-valve mask. Transportation to a hospital is necessary in these instances, as specialists are needed to replace the tube. First attempts at ventilation should be made over the mouth and nose. Be sure to cover the stoma. If this doesn’t appear to assist the child in his or her breathing, use a smaller mask and place it directly over the entrance to the trachea and direct the patient to keep his or her mouth closed.

3. Gastrostomy Tubes
Similar to tracheostomy tubes, gastrostomy tubes are inserted into a child’s abdomen to assist with the consumption of food. EMT-Basics are often called when a gastrostomy tube has been dislodged and parents cannot reinsert it. In this case, assess the patient as you would any other infant or child, paying close attention to the patient’s mental status. Ask the patient or the parents if the child is diabetic. If so, test for low blood sugar while transporting the patient to the hospital.

A tracheostomy tube is a small tube that is placed directly in the patient’s windpipe to assist in breathing.

4. Central Lines
Specialists often insert central lines into the veins of a child’s neck, chest, or groin to administer fluids or medications or to monitor central venous pressure. If a line is cracked or broken or the entrance to the line becomes infected or starts to bleed, parents often call EMS. You can manage the bleeding as you would any other wound, using a sterile dressing and applying pressure to the entrance of the line. This emergency requires transportation to the hospital to reinsert the central line and assess for further complications or damage.

5. Shunts
If you are responding to a child with a shunt (a tube), the illness or injury may be unrelated to the shunt entirely. You must still be aware of its presence, however. The most common shunt found in infants and children runs from the brain to the abdomen and works to drain excess fluid. These shunts are called central nervous system shunts.
Treat children with shunts similar to other children with medical problems or injuries and always be aware of their mental status. You may have to take special precautions when immobilizing these patients as you don’t want to damage the shunt in any way. Patients with shunts are also prone to respiratory arrest, so you should be prepared to administer ventilation at all times.

Related Topics You Should Review:
- Treating premature newborns with special needs
- Assessing children with neurological disorders
- Evaluating children with chronic diseases
- Responding to calls regarding children with altered functions
- Recognizing child abuse and neglect in children with special needs